Outcomes of gender-affirming sigmoid colon vaginoplasty: A retrospective study of 119 patients.

Abstract

Sigmoid colon vaginoplasty (SCV) is a recognized alternative to penile inversion vaginoplasty (PIV) for transgender and non-binary (TGNB) individuals seeking genital gender-affirming surgery. SCV provides self-lubricating mucosa, requires less dilation, enables a longer neovaginal canal, and may reduce the risks of stenosis and reoperation. This study evaluated the safety and efficacy of SCV and compared the outcomes between primary and revision cases. A retrospective review of TGNB patients who underwent SCV at a single center was conducted from December 2020 to June 2024. Patient demographics, operative details, and postoperative complications were analyzed, categorized as short-term (<30 days) or long-term (≥30 days). Among the 119 SCV cases, 66 (55.5%) were primary and 53 (44.5%) were revisions. Median age was 33 years, body mass index (BMI) was 28.5 kg/m², and operative duration was longer in primary cases (209 vs. 162 min, p<0.001). Median follow-up was 9.3 months. Short-term complications occurred in 21 (17.7%) patients, including full-thickness dehiscence (8.4%) and ileus (5.0%), with 6 (5.0%) requiring reoperation. Long-term complications affected 29 (24.4%) patients, primarily mucosal prolapse (11.8%), and introital stenosis (9.2%). Reoperations were necessary in 20 (16.8%) cases. Complication rates were similar between primary and revision cohorts. SCV is a safe and effective alternative to PIV, with comparable complication and reoperation rates. Although mucosal prolapse remains a concern, SCV may be preferable for patients with penoscrotal hypoplasia, higher BMI, or complete vaginal stenosis. Furthermore, patient preferences and tissue availability should guide surgical decisions.